You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Aortic Prosthetic Valve Endocarditis Caused by an Unusual Microorganism, Gemella sanguinis

Tiu, Ceres T. MD*; Lin, Yu Shia MD*; Speciale, Peter PhD; Shetty, Vijay MD; Ghitan, Monica MD*; Chapnick, Edward K. MD*

Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e31821d317d
Case Reports
Abstract

Introduction: We report the first case of prosthetic valve endocarditis caused by Gemella sanguinis.

Case: A 27-year-old woman with a history of rheumatic heart disease with mechanical aortic and mitral valve replacements reported a recent toothache treated with amoxicillin, with improvement. Several days later, she began to have intermittent fever, weakness, sore throat, and palpitations. A transesophageal echocardiogram revealed a 1.0-cm vegetation and suggestion of a perivalvular abscess, and blood culture grew Gemella sanguinis. The patient underwent a successful valve repair, and treatment with ceftriaxone was continued for a total of 6 weeks from the date of valve replacement.

Discussion and Conclusion: Gemella species are bacterial flora of the oropharyngeal, gastrointestinal, and/or urogenital tracts of humans. Most cases of native valve endocarditis reported have been attributed to G morbillorum and G haemolysans. The identification of Gemella isolates is a challenge. 16S ribosomal RNA gene sequencing was used as the method of choice for identifying Gemella; however, with the updated Vitek 2 colorimetric cards, Streptococcaceae including Gemella species were better identified. General principles of therapy for Gemella species are the same as for the nutritionally variant streptococci. Our patient had reported a toothache, and oral infection confirmed by dental evaluation was the likely source of bacteremia and endocarditis. Current recommendations for care at completion of treatment of endocarditis include a thorough dental evaluation. We suggest that oral health should be evaluated even before placement of the prosthesis.

Author Information

From the *Division of Infectious Diseases, †Department of Clinical Microbiology, and ‡Division of Cardiology, Maimonides Medical Center, Brooklyn, NY.

Correspondence to: Ceres T. Tiu, MD, Division of Infectious Diseases, Maimonides Medical Center, 4719 Fort Hamilton Parkway, Brooklyn, NY 11219. E-mail: ctiu@maimonidesmed.org.

The authors have no funding or conflicts of interest to disclose.

© 2012 Lippincott Williams & Wilkins, Inc.